Celebrex (Celecoxib) Discontinuation Prior to Epidural Injection
Celebrex does not need to be stopped prior to epidural injection, as COX-2 selective inhibitors (coxibs) are considered safe to continue during neuraxial procedures.
Key Recommendation
The French Working Group on Perioperative Haemostasis explicitly states that perioperative use of coxibs is possible in patients undergoing neuraxial procedures, unlike traditional NSAIDs which should be discontinued. 1
Rationale and Supporting Evidence
COX-2 Inhibitors vs Traditional NSAIDs
Traditional NSAIDs should not be administered perioperatively in patients requiring epidural procedures, but coxibs (like celecoxib) are specifically exempted from this restriction. 1
The distinction exists because celecoxib has minimal antiplatelet effects compared to non-selective NSAIDs, as it selectively inhibits COX-2 rather than COX-1, which is responsible for platelet function 2
Clinical Safety Data
Recent evidence from 2025 demonstrates that cervical transforaminal epidural steroid injections can be safely performed in patients continuing NSAIDs, with 763 procedures performed without any symptomatic epidural hematomas or bleeding complications. 3
This study included 2,792 total cervical epidural injections, with no reported bleeding complications in patients on various anticoagulants or NSAIDs 3
Pharmacokinetic Considerations
If discontinuation were necessary, celecoxib has a medium half-life of 7-15 hours, which would theoretically require only 1-2 days for clearance 4
However, given the explicit guideline exemption for coxibs in neuraxial procedures, routine discontinuation is not indicated 1
Important Caveats
This recommendation applies specifically to celecoxib as a COX-2 selective inhibitor; traditional NSAIDs (ibuprofen, naproxen, ketorolac) should still be discontinued 1-10 days before epidural procedures depending on their half-life 5
If the patient is on dual antiplatelet therapy or anticoagulation in addition to celecoxib, those medications require separate management according to established protocols 1
The safety profile may differ if the patient has other bleeding risk factors or is undergoing a particularly high-risk procedure 1